10/16/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS October - PDF document

10/16/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS October 16, 2019 A Proposed Standard of Care for Adult Obesity Treatment for All Providers Moderator: Lisa Diewald, MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education M. Louise Fitzpatrick College of Nursing Nursing Education Continuing Education Programming Research 1 FINDING SLIDES FOR TODAY’S WEBINAR www.villanova.edu/COPE Click on Dietz/Gallagher webinar description page Nursing Education Continuing Education Programming Research 2 DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR? If you are calling in today rather than using your computer to log on, and need CE credit, please email cope@villanova.edu and provide your name so we can send your certificate. Nursing Education Continuing Education Programming Research 3 1

10/16/2019 OBJECTIVES  Discuss the need for developing a standard of care of obesity treatment  Review the proposed standards of care for obesity treatment and the research leading up to their development  Identify how the proposed standards of care align with other obesity care guidelines, including obesity care competencies, development of an ideal benefit, and coverage for obesity treatment. Nursing Education Continuing Education Programming Research 4 CE DETAILS Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration Nursing Education Continuing Education Programming Research 5 CE CREDITS • This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians • Suggested CDR Learning Need Codes: 5370, 5410, 6000, 9020 • Level 2 • CDR Performance Indicators: 4.2.8, 6.1.6, 6.3.11, 8.2.5 Nursing Education Continuing Education Programming Research 6 2

10/16/2019 A Proposed Standard of Care for Adult Obesity Treatment for All Providers William H. Dietz, MD, PhD Chair, Sumner M. Redstone Center Milken Institute of Public Health Christine Gallagher, MPAff Research Project Director STOP Obesity Alliance 7 DISCLOSURE The planners of this program have no conflicts of interest to disclose. Dr. Dietz has disclosed a relationship with a commercial interest related to the content of this educational activity. The educational activity was reviewed and approved by the Nurse Planner for balance in the presentation and evidence-based content and absence of bias was confirmed. Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity. 8 Proposed Standard of Care for Adult Obesity Treatment William H. Dietz MD, PhD Chair Sumner M. Redstone Center 9 3

10/16/2019 Webinar Outline • Introduction to the STOP Obesity Alliance • Background for the proposed standard of care • Principles for all providers • Principles for clinical providers • The need for an essential obesity care benefit • Coverage 10 Purpose and Goals • Purpose: Convene a diverse group dedicated to reversing the obesity epidemic in the United States • Goals:  Lead Innovation  Strengthen systems of care  Convene diverse stakeholders  Define an innovative research agenda  Promote strategies to increase physical activity  Reduce stigma to improve health outcomes 11 Stakeholders Working Together to Advance Weight-Related Issues • 15 Steering Committee Members America’s Health Insurance Plans Gary Foster, PhD American Diabetes Association National Business Group on American Heart Association Health American Medical Group Association Obesity Action Coalition American Society for Metabolic Population Health Alliance & Bariatric Surgery The Obesity Society Donna Ryan, M.D. Trust for America’s Health • 60 Associate Member organizations (chronic disease, consumer, minority health, & provider groups) • 4 Corporate Members 12 4

10/16/2019 Provider Knowledge of Obesity Care is Limited Among family practitioners, internists, OB-GYNs, and nurse practitioners ( N = 1506 ): 49% Knew that ≥ 150 mins/week of physical activity was necessary to achieve sustainable health benefits 33% Knew that any suitable eating pattern can be recommended for weight loss (NHLBI guideline ) 16% Knew that 12-26 sessions during the first year is the recommended for patients with obesity Turner et al. Obesity 2018; 26:665 13 Identified Gaps in Patient-Provider Interactions TARGETS FOR IMPROVEMENT  Time is the most important barrier, but providers need tools and programs  Only 39% of adults with a BMI ≥ 30.0 recalled being told that they have obesity by a HCP  One - third of patients advised to lose weight were not given a plan to do so  Most PCPs say no one in their practice has been trained to deal with weight issues  Follow-up appointments are not scheduled 14 A Proposed Standard of Care Goal: provide a model of care for all those who care for people with obesity • Core principles of care • Standards of Care for all providers • Standards of Care for clinical providers (prescribers) • Coverage and payment policy standards 15 5

10/16/2019 Process for Developing a Standard of Care for Adult Obesity 2019 2018 2017 Proposed standard Three roundtable of care published meetings. Attendees Steering included over 50 Dietz, WH. and committee stakeholders, including Gallagher C,“A established and Proposed Standard health professionals who met in of Obesity Care for care for patients with All Providers and December obesity, community and Payers” Obesity ; non-clinic based 2019;27: 1059-1062. providers, payers, and patient advocates. 16 Core Principles of Care • Treat obesity as a chronic disease • Care should be evidence-based pragmatic and deliverable • Provide access to appropriate level of care, regardless of point of entry • Providers should be sensitive to bias and provide appropriate accommodation • Providers should be trained to initiate conversations about weight • Shared decision making and bidirectional communication • Evidence-based competencies that are discipline-specific should be met by each type of provider 17 Effects of Bias and Stigma • Experience of bias and stigma increases with the severity of obesity • Provider attitudes - people with obesity are lazy, lack self-control, and are blamed for their obesity • Perceived provider bias affects quality of care and mistrust makes patients less likely to seek care 18 6

10/16/2019 Effects of Bias and Stigma (cont.) • Bias is internalized as self-blame • Increased risk of depression, low self-esteem, and poor body image • Increased exposure with more severe obesity • Increased vulnerability to unhealthy behaviors that can contribute to weight gain 19 Accommodations • Provide wide-based, higher weight capacity chairs, preferably armless, in patient areas • Offer large size or thigh-sized cuffs BP cuffs • Provide a higher capacity scale, ideally > 500 lbs • Locate scale in a private or near-private area to minimize anxiety and discomfort associated with being weighed • Wheelchair accessible bathrooms • Install floor-mounted rather than wall-mounted toilets • Have extra-large gowns available • Educate staff about stigma and weight bias 20 People First Language • Overweight is a description • An “obese person” is an identity – he or she is obese, not a father, mother, or a person characterized by their achievements • An “obese person” is more likely to be held responsible tor their weight • Obesity is a disease • Describing a person with obesity focuses attention on cause 21 7

10/16/2019 Core Principles of Care • Treat obesity as a chronic disease • Care should be evidence-based pragmatic and deliverable • Provide access to appropriate level of care, regardless of point of entry • Providers should be sensitive to bias and provide appropriate accommodation • Providers should be trained to initiate conversations about weight • Shared decision making and bidirectional communication • Evidence-based competencies that are discipline-specific should be met by each type of provider 22 The Importance of Language Language to Use Language to Avoid Overweight Fat Increased BMI Obese Severe obesity Morbid obesity Unhealthy weight Healthier weight Improved nutrition Diet (or dieting) Physical activity Exercise 23 Efforts to Address Knowledge and Practice Gaps Why Weight? Provider Guide Initiate open, productive conversations about weight and health Assess patient readiness to change Engage in active listening Build trust Establish realistic goals Address culture and social barriers and supports www.whyweightguide.org 24 8